The Effect of Glycemic Control on Renal Triglyceride Content Assessed by Proton Spectroscopy in Patients With Type 2 Diabetes Mellitus: A Single-Center Parallel-Group Trial

Objective: Ectopic lipid accumulation in the kidney (fatty kidney) is a potential driver of diabetic kidney disease, and tight glycemic control can reduce risk of diabetic nephropathy. We assessed whether glycemic control influences renal triglyceride content (RTGC). Furthermore, we compared glucagon-like peptide-1 receptor agonist liraglutide versus standard glucose-lowering therapy. Design and Methods: In this single-center parallel-group trial, patients with type 2 diabetes mellitus were randomized to liraglutide or placebo added to standard care (metformin/sulfonylurea derivative/insulin). Changes in RTGC after 26 weeks of glycemic control measured by proton spectroscopy and difference in RTGC between treatment groups were analyzed. Results: Fifty patients with type 2 diabetes mellitus were included in the baseline analysis (mean age, 56.5 ± 9.1 years; range, 33-73 years; 46% males). Seventeen patients had baseline and follow-up measurements. Mean glycated hemoglobin was 7.8 ± 0.8%, which changed to 7.3 ± 0.9% after 26 weeks of glycemic control irrespective of treatment group (P =.046). Log-transformed RTGC was −0.68 ± 0.30% and changed to −0.83 ± 0.32% after 26 weeks of glycemic control irrespective of treatment group (P =.049). A 26-week-to-̶baseline RTGC ratio (95% confidence interval) was significantly different between liraglutide (−0.30 [−0.50, −0.09]) and placebo added to standard care (−0.003 [−0.34, 0.34]) (P =.04). Conclusion: In this exploratory study, we found that 26 weeks of glycemic control resulted in lower RTGC, in particular for liraglutide; however, larger clinical studies are needed to assess whether these changes reflect a true effect of glycemic control on fatty kidney.